ABSTRACT This is a K01 application for Dr. Amy Sims Sanyahumbi, a pediatric cardiologist at Baylor College of Medicine / Texas Children?s Hospital (BCM-TCH). Dr. Sanyahumbi is establishing herself as a young investigator in global pediatric cardi- ology, with the goal of working towards eradication of rheumatic heart disease (RHD). This K01 will provide her with support to achieve the following goals: (1) to become a global expert in RHD (2) to conduct investigations which will im- prove access and adherence to Benzathine Penicillin G (BPG) in people with RHD (3) to implement advanced biostatisti- cal methods in clinical studies, and (4) become an expert in electronic and mobile health technology that will benefit low and middle income countries (LMIC). To achieve these goals, she has assembled a mentoring team comprised of a prima- ry U.S. mentor, Dr. Kristy Murray, who has expertise in epidemiological methods, and a primary LMIC mentor, Dr. Peter Kazembe, who has extensive mentorship and clinical experience in Malawi. Also on her mentorship team are Dr. Mina Hosseinipour, a Malawian resident who is an expert in global research and mentorship, Dr. Craig Sable, a pediatric cardi- ologist with expertise in applying technology in low income settings, Dr. Daniel Penny, Chief of Pediatric Cardiology at BCM-TCH, and the world?s expert on RHD Dr. Jonathan Carapetis. RHD is preventable, yet continues to cause morbidity and mortality in LMICs. Secondary prevention with 4-weekly BPG has been shown to prevent RHD progression and im- prove RHD outcomes, yet previous studies have shown few people with RHD receive an adequate amount of prescribed injections to prevent advancement of disease. This study will (1) determine adherence to BPG by prospectively evaluating adherence to BPG among children with RHD. Dr. Sanyahumbi will also (2) provide a comprehensive assessment of (a) supply side (b) provider, and (c) patient factors affecting BPG access and adherence, thereby identifying targets to im- prove patient outcomes. Finally, the study will use barriers and facilitators identified in this work as a framework to devise a renewed strategy to improve BPG uptake and adherence. Dr. Sanyahumbi has the potential to become a world renowned global researcher. She has structured a training plan that includes didactic courses in a global masters of public health course, complemented by frequent and regular meetings with her mentorship team to discuss directed readings and topics relevant to her research and career development. Her diverse group of global mentors have expertise in mentorship, bio- stastical methods, global health ethics, RHD, and technological interventions in LMIC. She will be a part of the global research environment of BCM-TCH, Baylor-Malawi, and UNC-Malawi, which are all invested in Dr. Sanyahumbi and committed to the success of this research. RHD is a preventable disease that can have devastating consequence. This study will guide a generalizable systematic approach to improve BPG adherence and improve RHD outcomes. In addition, this award would prepare Dr. Sanyahumbi for an independent research career as she will develop an R01 supported trial eval- uating interventions to improve RHD outcomes before the end of this award period.